Payment Accuracy Specialist*

Cotiviti; United States; Remote; USD 44,000 - 51,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k)

Paid time off

Paid holidays

Job summary

Cotiviti is seeking a Payment Accuracy Data Mining Specialist to audit client data and generate high quality recoverable claims. You will work under direct supervision, building knowledge of CMS/NAIC guidelines and using RMS to review claims and reports.

Strong Excel skills and healthcare data understanding are essential for success. Responsibilities include auditing disputes, maintaining quality standards, and communicating findings to supervisory auditors for evaluation.

Qualifications

• High School Diploma is required.
• Bachelor’s degree preferred and/or 1–2 years healthcare experience.
• 1–2 years Cotiviti experience recommended for internal opportunities.
• Healthcare industry experience, including knowledge of Coordination of Benefits.
• Proficient with Microsoft Office (Word, Excel, Outlook).

Responsibilities

• Under direct supervision, audit client data and identify recoverable claims.
• Build familiarity with CMS and NAIC guidelines to determine liability.
• Use RMS and client systems to review reports and prepare documentation.
• Audit standard reports and paid claims for overpayments and underpayments.
• Meet productivity and quality standards and maintain attendance as required.
• Prepare responses to client disputes and review transactions with provider contracts.

Skills

Data mining

Audit experience

Microsoft Excel

Healthcare data

Education

High School Diploma

Bachelor’s degree

Tools

RMS

Client systems

Office Suite

Job description

Overview

A Payment Accuracy, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types.

A Payment Accuracy Data Mining (DM) Specialist is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed and validate the claim. Communicates audit recommendations to the supervisory auditor for evaluation, verification, and continuous learning. Displays professional skepticism that enhances the work performed to achieve success in the position.

Responsibilities

• This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work.
• Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability.
• Utilizes Cotiviti audit tools Recovery Management System (RMS), specific client systems) to complete auditing, review simple - medium proprietary reports, has a proficient understanding of Microsoft Excel and client applications.
• Audits standard reports and paid claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various clients. Assigned to simple - medium reports.
• Meets or exceeds standards for productivity, in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity for assigned work (i.e. hit rate, number of claims written, Identification (ID) per hour).
• Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed.
• Reviews client transactions by building personal proficiency around provider contracts and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept.
• Has a basic understanding of the healthcare industry, as well as proven track record of delivering results.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards.

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

Qualifications

• High School Diploma - Required.
• Bachelor’s degree (Preferred) and/or a minimum of at least one (1 -2) year/s related experience in healthcare.
• At least 1- 2 year/s Cotiviti experience is recommended for individuals seeking their next opportunity internally. (Example: Audit Support positions).
• Healthcare industry experience, including knowledge of Coordination of Benefits. (Preferred).
• Computer proficiency including Microsoft office (Word, Excel, Outlook).
• Excellent verbal and written communication skills.
• Strong interest in working with large data sets and various databases.
• Ability to work well in an individual and team environment demonstrating self–motivation to deliver success.

Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Mental Requirements:

• Communicating with others to exchange information.
• Assessing the accuracy, neatness, and thoroughness of the work assigned.

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide a dedicated, secure work area.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• No adverse environmental conditions expected.

Base compensation ranges from $21.00 to $24.75 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

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